Ask the Doctors February 2011 Issue

Ask The Doctors: February 2011

Iíve heard that statins can can help lower C-reactive protein (CRP) levels. Iím 65, but I donít take a statin because my cholesterol is low. Should I be concerned about CRP? I have a family history of heart disease.

Your question is timely, and very much on the cutting-edge of coronary artery disease (CAD) prevention. High cholesterol, or hyperlipidemia, is a well-known risk factor for CAD development, progression, and heart attack, known to doctors as myocardial infarction (MI). As established by the landmark Framingham Study, old age, male sex, hyperlipidemia, hypertension, smoking, and family history of CAD are also important risk factors. As you mention, it is reassuring that your cholesterol levels are under control.

However, it has come to light in recent years that other factors contribute to the risk of MI. Increased levels of inflammation are associated with a higher likelihood of MI, probably because inflammation inside coronary artery plaques makes them more likely to rupture and cause a heart attack. One way of measuring a personís bodywide level of inflammation is with the high-sensitivity C-reactive protein (hsCRP) blood test. A recent clinical trial (the JUPITER study) showed that patients with normal cholesterol levels and an elevated hsCRP level had fewer heart attacks, and lived longer, when they were treated with a statin (rosuvastatin), compared to those who received placebo. It was reasonably argued by the studyís authors that these benefits exceeded what would be expected from cholesterol reduction alone.

In large part due to the results of the JUPITER trial, we will often check hsCRP on patients with other risk factors for CAD (such as a family history), even if their cholesterol levels are normal. The decision of whether or not you should be treated with a statin should be made after careful consideration and discussion with your cardiologist. Please keep in mind that other ways exist of lowering hsCRP, including weight loss, exercise, dietary modification, and low-dose aspirin therapy.

Is there an age limit for weight loss surgeries, such as bariatric surgery? Iím 61, diabetic and very overweight. Iím eating healthier now, but I think I need a more drastic step to improve my health sooner than later.

No, there is no statute of limitations regarding age when bariatric, or weight-reduction surgery, is being considered. Thankfully, you have already been making important steps to improve your health, by improving your dietary habits. As you mention, undergoing a surgical procedure may be just what you need to lose considerable weight, and reduce your risk of eventual cardiovascular events, such as heart attack or stroke.

However, bariatric surgery is not something to be undertaken lightly. It is an intermediate-to-high risk procedure, and the presence of coronary artery disease (CAD) or heart failure may increase your risk of an unfavorable outcome. Given the fact that diabetes and overweight are significant risk factors for coronary disease, you should undergo cardiac stress testing before proceeding to bariatric surgery. That way, when you eventually undergo the procedure, it can be as safe as possible.

I recall reading that the motion-sickness drug Dramamine could help if youíre having a heart attack. Is that true?

The study you refer to appeared in the March 2010 issue of the journal Nature Biotechnology. The authors found that in laboratory animals (mice and rats), and in cell culture models, meclizine (one of two drugs marketed as Dramamine) helped to protect hearts from injury due to decreased blood flow. It was also found to decrease the size of strokes in mice. Apparently, meclizine alters energy use by cells, reducing the need for oxygen. Although these results are novel and exciting, more information is required regarding the helpfulness of such drugs in humans. Until then, we cannot recommend taking Dramamine in hopes of reducing the severity of a heart attack or a stroke.